Suprapubic Cystostomy: Risk Analysis of Possible Bowel Interposition Through the Percutaneous Tract by Computed Tomography
조규형, 두승환, 양원재, 송윤섭, 이경화,
소속 상세정보
조규형 ( Cho Kyu-Hyoung )
순천향대학교 의과대학 비뇨기과학교실
두승환 ( Doo Seung-Whan )
순천향대학교 의과대학 비뇨기과학교실
양원재 ( Yang Won-Jae )
순천향대학교 의과대학 비뇨기과학교실
송윤섭 ( Song Yun-Seob )
순천향대학교 의과대학 비뇨기과학교실
이경화 ( Lee Kyung-Hwa )
순천향대학교 의과대학 비뇨기과학교실
KMID : 0358320100510100709
Abstract
PurposeThe most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract.
Materials and MethodsFrom September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site.
ResultsA total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (≤11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract.
ConclusionsWhen performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus.
키워드
Complications;Cystostomy;Punctures
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